阿司匹林在不同年龄段脑梗死患者中二级预防的效果

doi:10.3969/j.issn.1004-583X.2016.02.016

摘要/Abstract

摘要： 目的探讨阿司匹林在不同年龄段脑梗死患者中二级预防的效果。方法将脑梗死患者分为暴露组(服用阿司匹林)与非暴露组(不服用阿司匹林或任何抗血小板药物),回顾性分析不同年龄段(41～50岁,51～60岁,61～70岁,71～80岁,81～90岁)脑梗死的复发、脑出血、蛛网膜下腔出血及消化道出血的发生率情况。结果与非暴露组比较,各个的年龄段暴露组(长期服用阿司匹林)脑梗死复发率明显降低;上消化道出血率明显增高(P＜0.05)。在61～90年龄段,暴露组脑出血和蛛网膜下腔出血增加趋势低于非暴露组(P＜0.05)。41～80岁年龄段,各暴露组脑出血率与蛛网膜下腔出血率比较无统计学意义(P＞0.05),而在71～90岁之间,各暴露组脑出血率与蛛网膜下腔出血率增加(P＜0.05)。需治疗例数在71～90岁年龄段增加(P＜0.05);在61～70岁年龄段相对危险度最高,81～90岁年龄段归因危险度最大。结论阿司匹林在不同年龄段脑梗死患者中二级预防效果存在差异,41～60岁之间应用阿司匹林进行二级预防获益最大,风险最小。

关键词: 脑梗死, 阿司匹林, 二级预防

Abstract: Objective To explore the secondary preventive effect of aspirin in different ages of patients with cerebral infarction.Methods A retrospective analysis was applied in all patients with cerebral infarction who were divided into five different age groups and every age group had the exposure group (aspirin treatment) and no-exposure group (control group). Recurrence of cerebral infarction, hemorrhage, subarachnoid hemorrhage and gastrointestinal bleeding were compared among groups.Results Incidence of recurrence of cerebral infarction in exposure groups were significantly lower than that of no-exposure groups (P＜0.05) and no-exposure groups had significantly lower incidence of gastrointestinal bleeding (P＜0.05) among different age groups. The increased incidence of cerebral and subarachnoid hemorrhage in exposure groups significantly decreased (P＜0.05) compared with no-exposure groups at 61-90 ages. In exposure groups at 41-80 ages, there were no significant difference in incidence of cerebral and subarachnoid hemorrhage (P＞0.05). However, the incidence of cerebral and subarachnoid hemorrhage raised significantly at 71-90 ages (P＜0.05). The number of patients who needed treat ment increased significantly at 71-90 ages (P＜0.05); The relative risk was highest at 61-70 ages and the attributive risk was highest at 81-90 ages.Conclusion There were differences in secondary prevention of aspirin in different ages of patients with cerebral infarction. There were maximum benefit and minimum risk to have secondary prevention of aspirin in patients with cerebral infarction at 41-60 ages.

Key words: cerebral infarction, aspirin, secondary prevention

中图分类号:

R743.33

吴学永,卢常盛,李上华,黄雄,李春梅. 阿司匹林在不同年龄段脑梗死患者中二级预防的效果[J]. 临床荟萃, 2016, 31(2): 201-203.

Wu Xueyong, Lu Changsheng, Li Shanghua, Huang Xiong, Li Chunmei. Clinical study of secondary prevention of aspirin in different ages of patients with cerebral infarction[J]. Clinical Focus, 2016, 31(2): 201-203.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2016.02.016

https://huicui.hebmu.edu.cn/CN/Y2016/V31/I2/201

参考文献

[1] 沈设芬, 李瑛, 毛云英,等. 康复护理对老年脑梗死患者认知及预后的影响[J]. 中国初级卫生保健, 2012, 26(4):98-99.
[2] Mostaza JM, Martín-Jadraque R, Vicente I, et al. Patients at high risk of cerebrovascular disease: the REACH study[J]. Cerebrovasc Dis, 2009, 27(Suppl 1):77-81.
[3] Shinohara Y, Katayama Y, Uchiyama S, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial[J]. Lancet Neurol, 2010, 9(10):959-968.
[4] 王新德. 各类脑血管疾病诊断要点[J]. 中国乡村医药, 1996, (2):10-11.
[5] Bousser MG, Amarenco P, Chamorro A. Terutroban versus aspirin in patients with cerebral ischaemic events (PERFORM): a randomised, double-blind, parallel-group trial[J]. Lancet, 2011, 377(9782):2013-2022.
[6] 赵玥. 急性脑梗死的颈动脉内中膜厚度与血清高敏C反应蛋白、纤维蛋白原和同型半胱氨酸关系[J].临床荟萃, 2014, 29(2):168-170.
[7] 许伟,宋新军,赵林,等.丹参多酚酸对脑梗死患者的疗效及对同型半胱氨酸的影响[J].河北医科大学学报,2015,36(9):1053-1055.
[8] 汝童, 付朝霞, 王珊珊,等. 阿司匹林引发上消化道出血的相关危险因素研究[J]. 现代生物医学进展, 2015, 15(4):664-667.
[9] 钟金菊, 方柳成. NSAIDs致上消化道出血的临床特点分析[J]. 临床医学工程, 2012, 19(8):1316-1317.
[10] Ke L, Ni HB, Tong ZH, et al. D‐dimer as a marker of severity in patients with severe acute pancreatitis[J]. J Hepatobiliary Pancreat Sci, 2012, 19(3): 259-265.
[11] 雷建明,廖耿,黄伟.机械取栓与动静脉联合溶栓治疗急性脑梗死临床效果及预后分析[J].解放军医药杂志,2015,27(4):53-55.
[12] Perk J, De Backer G, Gohlke H, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012) : the fifth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)[J]. Int J Behav Med, 2012,19(4):403-488.
[13] 孙毅鸿, 邵伟, 王怡,等. 上消化道出血危险因素的巢式病例对照研究[J]. 药物流行病学杂志, 2012, (10):473-476.
[14] 陈东尔. 小剂量阿司匹林致上消化道出血患者83例临床分析[J]. 当代医学, 2012, 18(25):135-136.
[15] 任仲玉, 任德旺, 任仲杰,等. 小剂量阿司匹林所致出血等不良反应状况调查[J]. 中国药物评价, 2013, 30(5):288-290.
[16] 谭劼, 铁玉萍, 张红雨,等. 无上消化道症状的阿司匹林相关上消化道出血临床分析[J]. 中国临床研究, 2010, 23(10):876-877.
[17] 黄荣华, 马爱霞, 李洪超. 阿司匹林和氯吡格雷治疗老年冠心病疗效及安全性的Meta分析[J]. 中国药物评价, 2013, 30(2):100-106.
[18] 陈铁强.急性脑梗死的院前急救116例分析[J].中国实用医药,2011,6(3):130-131.
[19] 闫文文.血栓通治疗难治性肾病综合症的临床疗效观察[J].贵阳中医学院学报,2010,32(2):25-26.
[20] Kuwashiro T, Toyoda K, Oyama N, et al. High plasma D-dimer is a marker of deep vein thrombosis in acute stroke[J]. J Stroke Cerebrovasc Dis, 2012, 21(3): 205-209.